NC0004839_ORC Designation Form_20240827

Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation Form
Facility Name
CHARLOTTE TERMINAL 2
NCAC 15A 8G .0201
TAB to Navigate Farm
Permit # NC0004839
Facility Type/Classification: PC Facility Grade: I SUBMIT A SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name; Kinder Morgan Southeast Terminals 1 Wayne Harvey
Email Address: [e-mail]
Permittee Signature: Date:
ORC
Full Name: Joseph Byers
Email Address. [e-mail]
8/27/24
Work Phone: [phone]
Certificate Type: PC Certificate Grade: I Certificate #: 1010231
�I - " Effective Date: ��Z
Signature: 'Fr � 6
"I certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as setforlh in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name: Matthew Joseph Brundage Work Phone: [phone]
Certificate Type: PC
Certificate Grade: I
Certificate #:
1002738
Signature: '`� .�``"`"�"Effective Date: August 26, 2024
"I certify that I agree to my designation us the Operator in Responsible Charge for the facility noted. I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G.0204 and falling to do so can result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name: Gary W Simcox Work Phone: [phone]
Certificate Type: PC Certificate Grade:
Certificate #: 28893
Signature: Effective Date: August 26, 2024
certify that/ agree to my designation as the Operator in Responsible Charge for the facility noted. l understand and will abide by the rules and regulations
pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by tire WPCSOCC'
Email this form to: [e-mail]
AND
Send to your DEQ Regional Office (send to your contact or find emails here: www.deq.nc.gov/about/contact/regional-offices
or fax using this drop down list:I Mooresville-610 E. Center Ave., Suite 301, Mooresville, NC 28115 ] FAX: [phone] j PH: 704-663-�
Use the 2nd page only it you need to list additional Backups.
Revised 0212024

Facility Name: CHARLOTTE TERMINAL 2 Permit NC0004839
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select
Certificate ti:
Signature:
Effective Date:
"I certify that I agree to my designation as the Opemtorin Responsible Chorge for thefac8lty noted.
I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth In 15A NCAC 08G.0204 and falling to do so can result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select
Certificate M
Signature:
Effective Date:
"I certify that I agree to my designation as the Operatorin Responsible Chorge for the facility noted.
1 understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORCos set forth in 15A NCAC08G.0204 and foiling to do so can result In Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select
Certificate M
Signature:
Effective Date:
"I certify that I agree to my des/gna0an as the Operatorin Responsible Chorge for the face ity noted.
I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORCosset forth in 15A NCAC08G.0204 and falling to do so con result in Disciplinary Actions by the WPCSOCC"
Backup OR
Full Name:.
Work Phone:
Certificate Type: Select Certificate Grade: Select
Certificate M
Signature:
Effective Date:
"I certyy that I agree to my designation as the Operator in Responsible Charge for the facility noted.
I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as setforth in 15A NCAC 08G.0204 and falling to do so can result in
Disciplinary Actions by the WPCSOCC"
Revised 0212024